Menopause

Overview

What is menopause?

Menopause is when a woman’s menstrual periods permanently end. It happens because, as a woman ages, her ovaries make less of the female hormones estrogen and progesterone. These are the hormones that regulate your menstrual cycle. The timing of actual menopause is different for each woman, but it's normal for menopause to occur any time from age 40 to age 59. Menopause is a gradual process that can take a number of years.

Perimenopause is the term for the 3 to 5 years around the time of menopause and before your final period.

Symptoms

What are the common signs and symptoms of menopause?

Some women just stop having periods. Most women experience some symptoms, such as the following:

A change in your menstrual cycle. This is one of the first signs of menopause. You may skip periods or they may occur closer together. Your flow may be lighter or heavier than usual.

Hot flashes. Hot flashes are the most common symptom of menopause. When you have a hot flash, you'll feel warm from your chest to your head, often in wave-like sensations. Your skin may turn red and you may sweat. You may feel sick to your stomach and dizzy. You may also have a headache and feel like your heart is beating very fast and hard.

Vaginal dryness. During and after menopause, the skin of your vagina and vulva (the area around your vagina) becomes thinner. Your vagina also loses its ability to produce as much lubrication (wetness) during sexual arousal. These changes can lead to pain during sex.

You can use an over-the-counter water-based sexual lubricant (such as K-Y Jelly) or moisturizers for the vaginal area (such as Vagisil) to make sex less painful. You can also talk to your doctor about the benefits and risks of using prescription estrogen cream for vaginal changes.

Urinary tract problems. You're more likely to have bladder and urinary tract infections during and after menopause. Talk to your doctor if you have to go to the bathroom often, feel an urgent need to urinate, feel a burning sensation when urinating or are not able to urinate.

Headaches, night sweats, trouble sleeping and tiredness are other symptoms. As you’re going through menopause, you may have trouble falling asleep or staying asleep. Night sweats may wake you up. You may not get enough rapid eye movement (REM) sleep (the stage of sleep during which you dream). A lack of REM sleep may make you feel tired, moody and stressed out.

Weight gain. Many women gain weight during menopause. A healthy diet and exercising most, if not all, days of the week will help keep you fit.

Talk to your doctor if you have:

A change in your monthly cycle

Heavy bleeding

Bleeding that lasts longer than usual

Bleeding more often than every 3 weeks

Bleeding after sexual intercourse

Any blood spotting between periods

Does menopause have emotional symptoms?

Many women experience emotional symptoms during menopause. These symptoms may include sadness, anxiety and mood swings. For some women, symptoms can be severe. If you find that you're having emotional problems, talk to your family doctor.

When does menopause occur?

The timing of actual menopause is different for each woman. The average age for women to have their last period is about 51. But it's normal for menopause to occur any time from age 40 to 59. A woman often goes through menopause at about the same age as her mother. If you stop having periods early (before age 40) your doctor can do a blood test to see if you're actually going through menopause or if there is another cause for your missed periods.

Menopause is a gradual process that can take several years. You're not really through menopause until you haven't had a period for 12 months. (During this time, keep using birth control if you don't want to become pregnant.)

Women who have both ovaries removed during surgery will go through "surgical menopause" at the time of their surgery. If the uterus is taken out but the ovaries are not, a woman will stop having periods, but she will not go through surgical menopause.

Treatment

What is hormone replacement therapy?

Hormone replacement therapy (HRT) is a treatment for menopause symptoms that involves taking synthetic hormones (which are made in a laboratory rather than by the body). HRT can be estrogen taken alone or estrogen combined with another hormone, progestin. Some women have found that HRT can relieve symptoms such as hot flashes, vaginal dryness and some urinary problems. However, HRT is not for everyone. New information from recent studies suggests that for most women, the risks of using HRT may outweigh the benefits. Talk to your doctor about the risks and benefits of HRT.

Are other treatments available?

Yes. Medicines such as estrogen cream, low-dose antidepressants, soy products and certain herbal supplements may help ease some menopausal symptoms. Discuss these options with your doctor.

What are phytoestrogens?

Phytoestrogens are plant-based substances found in some cereals, vegetables, beans and other legumes, and herbs. They may work in the body like a weak form of estrogen. Researchers are studying whether phytoestrogens can be used to relieve some symptoms of menopause. They are also studying the side effects caused by these substances.

Many soy products, such as tofu, tempeh, soymilk and soy nuts, are good sources of phytoestrogens. Some studies indicate that soy supplements may reduce hot flashes in women after menopause. However, the results haven’t been consistent.

There is not enough scientific evidence to recommend the use of herbs that contain phytoestrogens to treat symptoms of menopause. This is also true of pills and creams made with these herbs. In addition, not enough is known about the risks of using these products. Herbs and supplements are not regulated in the way that medicines are. Some herbs and supplements can be harmful when combined with certain medicines. If you’re considering using any natural or herbal products to ease your symptoms, talk to your doctor first.

Should I avoid certain foods or drinks during menopause?

If you have hot flashes, you may want to avoid spicy or hot foods and drinks. These can trigger hot flashes. Alcohol can trigger hot flashes, too. It also interferes with bone growth and calcium absorption. Women who are going through menopause should avoid or limit alcohol.

Can my diet affect how well I sleep?

The following tips can help reduce sleep problems:

Eat regular meals at regular times.

Avoid late-night meals and heavy late-night snacks.

Limit caffeine, which is found in coffee, tea, chocolate and cola drinks. Caffeine stays in the bloodstream for up to 6 hours and can interfere with sleep.

Avoid alcohol. It may make you feel sleepy, but it actually affects the cycle of REM and non-REM sleep. This may cause you to wake up throughout the night.

Help for hot flashes

Turn your thermostat down. Sleep in a cool room.

Dress in layers, so you can remove clothing when you get too warm.

Wear cotton and other natural fabrics that "breathe" so you don't get overheated. Use cotton sheets on your bed.

Drink cool water or other beverages when a hot flash starts.

Get plenty of exercise.

Find out what triggers your hot flashes and avoid them. Spicy foods, alcohol, tight clothing and hot humid weather are some common triggers.

Complications

How does menopause affect bone health?

The older a woman is, the greater her risk of osteoporosis. A woman’s risk becomes even greater when she goes through menopause. When your estrogen level decreases during menopause, you lose more bone than your body can replace. This makes your bones weaker and more likely to break. To keep your bones strong, it’s important to get enough calcium and vitamin D in your diet, which helps your body absorb calcium.

Your doctor can suggest ways to get more calcium through food, drink and, possibly, a calcium supplement. He or she may also suggest that you take a vitamin D supplement to help your body process calcium. Ask your doctor what amount of daily calcium and vitamin D is right for you.

In general, women 30 to 50 years of age need 1,000 mg of calcium each day. Women older than 50 years of age need 1,200 mg of calcium each day. Milk, yogurt and other dairy foods are good sources of calcium. Soybeans, broccoli and tofu are, too.

Women 30 to 70 years of age usually need at least 600 international units (IU) of vitamin D each day. Women older than 70 years of age need at least 800 IU of vitamin D each day. Fatty fish, such as salmon and tuna, is a good source of vitamin D.

How does menopause affect heart health?

Women are more likely to develop heart disease after menopause. Lower estrogen levels may be part of the cause, in addition to other health issues that are more common as women get older. These include gaining weight, becoming less active, and developing high blood pressure or diabetes. You can reduce your risk of these health problems by eating a variety of healthy, nutrient-rich foods, staying active and maintaining an appropriate weight.

How does menopause affect iron levels in my blood?

If you are still having periods as you go through menopause, you may continue to be at risk of a low iron level, especially if your bleeding is heavy or you spot between periods. This can lead to anemia. Eating at least 3 servings of iron-rich foods a day will help you get enough iron in your diet. Good sources of iron include spinach, beans and meat. Your doctor may also suggest that you take an iron supplement.